Abstract

Despite the widespread availability of antiretroviral therapy, Cytomegalovirus (CMV) infection remains an important cause of morbidity and mortality in sub-Saharan Africa. CMV gastrointestinal tract infection is poorly described. This retrospective study was undertaken to describe the clinical and histological features of biopsy confirmed CMV infection of the gastrointestinal tract in a large teaching hospital with a high prevalence of Human Immunodeficiency Virus (HIV) infection. A total of 53 tissue biopsies from 47 patients and 58 topographic sites were included. Forty (91%) adults had a predisposing condition; 32 (73%) were HIV infected. The median adult age was 41 years and 61% were female. The sites involved were oesophagus (35%), colon (24%), small intestine (21%), stomach (14%) and anus (7%). Four patients had intestinal perforation. Ulcers were the most frequent endoscopic finding but 25% had 'pseudotumours'. No relationship was noted between the degree of inflammation and the load of CMV infected cells assessed microscopically. Endothelial cells were most commonly infected and Cryptosporidium and Helicobacter were the commonest co-pathogens. This study highlights important features of CMV infection in the gastrointestinal tract especially with regard to HIV infected patients who formed the majority of our cohort.

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